The materiality of a fact is determined by the circumstances of each case and is a question of fact. A fact to be material has to have a direct bearing on the cause of death, and mere proximity to the case of death or any incidental relation to it would not suffice.

TRIBHUVAN DAHIYA J.

This petition has been filed seeking a writ of certiorari for quashing the order dated 12.4.2017 (Annexure P-4) passed by the Insurance Ombudsman regarding claim submitted by the petitioner/insured’s wife towards Policy No.15512190 (commencement date 12.10.2012, and conveyed on 17.10.2012) and Policy No.16464208 (commencement date 3.12.2013, issued on 26.12.2013, and conveyed on 27.12.2013). the claims were repudiated by the respondents/Insurance company on account of suppression of relevant information at the time of taking the life insurance policies. Further, the petitioner is seeking a writ of mandamus directing the respondents to pay the insurance amount in terms of the aforesaid policies with interest at the rate of 18% per annum from the due date, i.e., death of the petitioner’s husband, till realisation.

2. Facts of the case in brief are, the petitioner’s husband filled-up the proposal forms (Annexures R-2/1 and R-2/3 respectively), and the aforementioned two insurance policies (Annexures R-2/2 and R-2/4) were issued to him on 17.10.2012 and 27.12.2013 respectively. The insured/petitioner’s husband died on 3.8.2015. The petitioner approached the Insurance company by submitting a ‘death claim form’ dated 24.8.2015 alongwith requisite documents, including the Doctor’s Certificate as also the discharge summary (Annexure R-2/5). The claim was, however, repudiated by the Insurance company on the ground of concealment of relevant information. The Doctor’s Certificate submitted alongwith the ‘death claim form’ revealed that the deceased was a chronic patient of diabetes and hypertension (hereinafter referred to as ‘the chronic disease’) for the last fifteen years. This shows, at the time of taking the insurance policies he was suffering from pre-existing illness, which was not disclosed to the Insurance company.

3. The repudiated claims were approved by the Claimants Review Committee of the Insurance company. The petitioner was, thereafter, asked to approach the Insurance Ombudsman/respondent no.1. Death claims in respect of the two policies were submitted before the Ombudsman on 24.3.2016 (Annexures P-6 and P-7). The same were, however, rejected by respondent no.1 vide order dated 12.4.2017 (Annexure P-4), accepting the ground of repudiation of the claims by the Insurance company.

4. Learned Senior counsel for the petitioner contends that the death claim was wrongly rejected by the respondents, since there was no material concealment of any fact by the deceased at the time of taking the insurance policies. He contends, the fact that deceased was suffering from diabetes and hypertension was not to his knowledge at the time of taking the policies, the same, accordingly, could not have been disclosed by him. He further contends that even otherwise, this is not a material fact which was required to be disclosed at the time of taking the policies. He has relied upon the judgment of this Court passed in Vidya v. Life Insurance Corporation of India and another, 2004 (3) RCR (Civil) 793. He contends that mere inaccuracy of statement at the time of taking the insurance policies cannot be a ground for repudiating the claim after two years. Section 45 of the Insurance Act, 1938 (for short ‘the Act’), prevents the respondents from doing so. He has further referred to a judgment of the Supreme Court passed in Manmohan Nanda v. United India Assurance Company Limited and another, 2022 (4) SCC 582, to contend that as the deceased/insured himself was not aware of the stated ailment, the claims could not have been rejected by the respondents.

5. Learned counsel for the Insurance company, on the contrary, contends that there is a clear violation of terms of the insurance policies by the deceased. He concealed vital information at the time of taking the policy that he was a chronic patient of diabetes mellitus and hypertension (DM and HTN). Therefore, the contract of insurance between the parties was void being in violation of th